肾绞痛的药物治疗选择: 一项中国泌尿外科医生用药的现况调查

doi:10.19723/j.issn.1671-167X.2023.05.015

摘要/Abstract

摘要：

目的: 调查中国泌尿外科医生对肾绞痛的认知和管理现状。方法: 在2021年11月至2022年3月期间，以调查问卷的形式调查了中国各地725名泌尿外科医生，问卷内容包括医生所在省份、所在医院等级、职称、每周诊治肾绞痛患者数量、肾绞痛的首选药物以及对该病的认知情况等。结果: 回收有效问卷720份(占总数的99.31%)，其中42.4%的医生首选药物为非甾体类抗炎药(non-steroidal anti-inflammatory drugs，NSAIDs)，40.0%的医生首选解痉药，11.0%的医生首选阿片类药物，6.6%的医生选择其他治疗方法。另外，61.1%的医生对肾绞痛产生机制的认识为前列腺素(prostaglandins，PGs)升高，32.2%的医生认为是输尿管痉挛，5.0%的医生认为是结石刺激，1.7%的医生认为机制不明确。医生对肾绞痛疼痛产生机制的认知情况对首选治疗药物的选择具有显著影响(χ²=54.399，P < 0.001)，认为PGs升高的医生比选择输尿管痉挛和结石刺激的医生更常首选NSAIDs(51.6% vs. 28.0%，χ²=34.356，P < 0.001；51.6% vs. 19.4%，χ²=13.759，P < 0.001)。除此之外，医院等级、医生职称和的医生每周诊治量都会影响医生对肾绞痛的首选药物(P < 0.05)，三级医院、中高级职称和每周诊治>8例肾绞痛患者的医生通常更多会首选NSAIDs。结论: 被调查的中国泌尿外科医生对于肾绞痛的认知及药物治疗方面存在不足，首选药物的选择与医生对疾病的认知、所在医院等级、医生的职称及每周诊治量相关。

关键词: 肾绞痛, 药物治疗, 现况调查

Abstract:

Objective: To investigate the status quo of recognition and management of renal colic among urological surgeons in China. Methods: From November 2021 to March 2022, 725 urological surgeons in China were surveyed in the form of a questionnaire, including their province, hospital grade, professional title, the number of patients with renal colic treated per week, the preferred drugs and the cognition of the disease. This study was approved by the Medical Ethics Committee of Peking University People's Hospital, and all respondents completed informed consent online. Results: During November 2021 and March 2022, urological surgeons across China were surveyed in the form of a questionnaire, and the reliability and validity of the questionnaire were verified before the study was carried out. In the study, 720 valid questionnaires were collected (accounting for 99.31% of the total number), in which 42.4% of the doctors' preferred drugs were non-steroidal anti-inflammatory drugs (NSAIDs), and 40.0% of the doctors' preferred antispasmodic drugs. Opioids were the first choice of 11.0% of the physicians and other treatments were preferred by 6.6% of physicians. In addition, 61.1% of the doctors thought that the mechanism of renal colic was elevated prostaglandin, 32.2% thought it was ureteral spasm, 5.0% thought it was calculi irritation, and 1.7% thought the mechanism was unclear. The doctor of the cognition of the generation mechanism of renal colic pain had a significant influence on the preferred treatment option (χ²=54.399, P < 0.001) that the "elevated prostaglandins" doctor more often preferred NSAIDs than the doctor who thought cramps and ureter stones caused renal colic (51.6% vs. 28.0%, χ²=34.356, P < 0.001;51.6% vs. 19.4%, χ²=13.759, P < 0.001). In addition, hospital class, physician title, and the number of weekly consultations by physicians influenced the choice of medications for renal colic (P < 0.05), tertiary hospitals, middle and senior professional titles and weekly patients with renal colic > 8 cases generally preferred NSAIDs. Conclusion: There are deficiencies in the cognition and drug treatment of renal colic among urological surgeons in China. The choice of the preferred drug was related to the doctor's cognition of the disease, the grade of the hospital, the doctor's professional title and the weekly treatment volume.

Key words: Renal colic, Drug treatment, Status survey

中图分类号:

R692.2

王明瑞,姬家祥,赖金惠,唐鑫伟,胡浩浦,王起,许克新,徐涛,胡浩. 肾绞痛的药物治疗选择: 一项中国泌尿外科医生用药的现况调查[J]. 北京大学学报（医学版）, 2023, 55(5): 871-875.

Ming-rui WANG,Jia-xiang JI,Jin-hui LAI,Xin-wei TANG,Hao-pu HU,Qi WANG,Ke-xin XU,Tao XU,Hao HU. Choice of medical treatment for renal colic: A survey of Chinese urologists[J]. Journal of Peking University (Health Sciences), 2023, 55(5): 871-875.

图/表 4

表1

表2

表3

表4

参考文献 21

1	Ayan M , Sogut E , Tas U , et al. Pain levels associated with renal colic and primary dysmenorrhea: A prospective controlled study with objective and subjective outcomes[J]. Arch Gynecol Obstet, 2012, 286 (2): 403- 409. doi: 10.1007/s00404-012-2316-4
2	米华, 邓耀良. 中国尿石症的流行病学特征[J]. 中华泌尿外科杂志, 2003, 24 (10): 715- 716.
3	曾国华, 麦赞林, 夏术阶, 等. 中国成年人群尿石症患病率横断面调查[J]. 中华泌尿外科杂志, 2015, 36 (7): 528- 532. doi: 10.3760/cma.j.issn.1000-6702.2015.07.014
4	Steinberg PL , Chang SL . Pain relief for acute urolithiasis: The case for non-steroidal anti-inflammatory drugs[J]. Drugs, 2016, 76 (10): 993- 997. doi: 10.1007/s40265-016-0595-y
5	Perlmutter A , Miller L , Trimble LA , et al. Toradol, an NSAID used for renal colic, decreases renal perfusion and ureteral pressure in a canine model of unilateral ureteral obstruction[J]. J Urol, 1993, 149 (4): 926- 930. doi: 10.1016/S0022-5347(17)36261-4
6	Davenport K , Waine E . The role of non-steroidal anti-inflammatory drugs in renal colic[J]. Pharmaceuticals (Basel), 2010, 3 (5): 1304- 1310. doi: 10.3390/ph3051304
7	黄健. 中国泌尿外科和男科疾病诊断治疗指南(2019版)[M]. 北京: 科学出版社, 2020: 237- 267.
8	Turk C , Petrik A , Sarica K , et al. EAU guidelines on diagnosis and conservative management of urolithiasis[J]. Eur Urol, 2016, 69 (3): 468- 474. doi: 10.1016/j.eururo.2015.07.040
9	宁本翔, 孙西钊, 周乐卿, 等. 上尿路结石导致肾绞痛的急诊处理: 南京地区现况调查[J]. 中华泌尿外科杂志, 2014, 35 (2): 95- 97.
10	Lasoye TA , Sedgwick PM , Patel N , et al. Management of acute renal colic in the UK: A questionnaire survey[J]. BMC Emerg Med, 2004, 4 (1): 5. doi: 10.1186/1471-227X-4-5
11	Bounes V , Valle B , Concina F , et al. Treatment of acute renal colic in US and French EDs: Simulated cases and real cases in acute pain management[J]. Am J Emerg Med, 2016, 34 (10): 1955- 1958. doi: 10.1016/j.ajem.2016.06.107
12	Pathan SA , Mitra B , Cameron PA . A systematic review and meta-analysis comparing the efficacy of nonsteroidal anti-inflammatory drugs, opioids, and paracetamol in the treatment of acute renal colic[J]. Eur Urol, 2018, 73 (4): 583- 595. doi: 10.1016/j.eururo.2017.11.001
13	Afshar K , Jafari S , Marks AJ , et al. Nonsteroidal anti-inflammatory drugs (NSAIDs) and non-opioids for acute renal colic[J]. Cochrane Database Syst Rev, 2015, 29 (6): CD006027.
14	Gu HY , Luo J , Wu JY , et al. Increasing nonsteroidal anti-inflammatory drugs and reducing opioids or paracetamol in the management of acute renal colic: Based on three-stage study design of network meta-analysis of randomized controlled trials[J]. Front Pharmacol, 2019, 22 (10): 96.
15	Papadopoulos G , Bourdoumis A , Kachrilas S , et al. Hyoscine N-butylbromide (Buscopan^®) in the treatment of acute ureteral colic: What is the evidence?[J]. Urol Int, 2014, 92 (3): 253- 257. doi: 10.1159/000358015
16	Tomiak RH , Barlow RB , Smith PJ . Are there valid reasons for using anti-muscarinic drugs in the management of renal colic?[J]. Br J Urol, 1985, 57 (5): 498- 499. doi: 10.1111/j.1464-410X.1985.tb05854.x
17	Holdgate A , Oh CM . Is there a role for antimuscarinics in renal colic? A randomized controlled trial[J]. J Urol, 2005, 174 (2): 572- 575. doi: 10.1097/01.ju.0000165337.37317.4c
18	Gurbuz MC , Polat H , Canat L , et al. Efficacy of three different alpha 1-adrenergic blockers and hyoscine N-butylbromide for distal ureteral stones[J]. Int Braz J Urol, 2011, 37 (2): 195- 200. doi: 10.1590/S1677-55382011000200006
19	Lu Z , Dong Z , Ding H , et al. Tamsulosin for ureteral stones: A systematic review and meta-analysis of a randomized controlled trial[J]. Urol Int, 2012, 89 (1): 107- 115. doi: 10.1159/000338909
20	Meltzer AC , Burrows PK , Wolfson AB , et al. Effect of tamsulosin on passage of symptomatic ureteral stones: A randomized clinical trial[J]. JAMA Intern Med, 2018, 178 (8): 1051- 1057.
21	Law YXT , Teoh JYC , Castellani D , et al. Role of pre-operative ureteral stent on outcomes of retrograde intra-renal surgery (RIRS): Systematic review and meta-analysis of 3 831 patients and comparison of Asian and non-Asian cohorts[J]. World J Urol, 2022, 40 (6): 1377- 1389.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

First-line drugs	Elevated PGs (n=440)	Ureteral spasm (n=232)	Stone stimulation (n=36)	Not aware (n=12)
NSAIDs, n (%)	227 (51.6)	65 (28.0)	7 (19.4)	6 (50.0)
Opioids, n (%)	42 (9.5)	29 (12.5)	5 (13.9)	3 (25.0)
Antispasmodics, n (%)	142 (32.3)	125 (53.9)	18 (50.0)	3 (25.0)
Other drugs, n (%)	29 (6.6)	13 (5.6)	6 (16.7)	0

First-line drugs	Grade Ⅰ and Ⅱ (n=165)	Grade Ⅲ (n=555)
NSAIDs, n (%)	52 (31.5)	253 (45.6)
Opioids, n (%)	26 (15.8)	53 (9.6)
Antispasmodics, n (%)	72 (43.6)	216 (38.9)
Other drugs, n (%)	15 (9.1)	33 (5.9)

First-line drugs	Resident (n=134)	Attending (n=304)	Associate professor (n=199)	Professor (n=83)
NSAIDs, n (%)	46 (34.3)	120 (39.5)	102 (51.3)	37 (44.6)
Opioids, n (%)	11 (8.2)	41 (13.5)	16 (8.0)	11 (13.3)
Antispasmodics, n (%)	73 (54.5)	119 (39.1)	73 (36.7)	23 (27.7)
Other drugs, n (%)	4 (3.0)	24 (7.9)	8 (4.0)	12 (14.5)

First-line drugs	≤8 cases/week (n=367)	＞8 cases/week (n=352)
NSAIDs, n (%)	138 (37.6)	166 (47.2)
Opioids, n (%)	49 (13.4)	30 (8.5)
Antispasmodics, n (%)	155 (42.2)	133 (37.8)
Other drugs, n (%)	25 (6.8)	23 (6.5)